Friday, January 22, 1999 Published at 19:27 GMTHealthMental Health Act 1983The mentally ill can be detained under the Mental Health ActA shake-up of mental health legislation is expected to be announced by the government in the autumn, following a review by a panel of experts. Mental health charities believe patients and their carers need to be given more rights, but they are split on a proposal for community care patients to be forced to take their medication or face being returned to hospital.

Who is detained under mental health legislation?

The Mental Health Act of 1983 covers the detention of people deemed a risk to themselves or others.

The first two are generally interpreted as people with learning difficulties who have aggressive tendencies.

Psychopathic disorder relates to people who have a "persistent disorder or disability of the mind" which leads to aggression.

There is much controversy about this category with some psychiatrists arguing that many people with personality disorders fall outside the Act because their condition cannot be improved with treatment.

The government is proposing indefinite sentences for people with serious personality disorders, whether or not they have committed a crime.

Mental illness itself is not defined by the Act. However, it does state what it does not cover.

This includes people who may be deemed to be mentally ill "by reason only of promiscuity or other immoral conduct, sexual deviancy or dependence on alcohol or drugs".

In the past, single women who got pregnant were often confined to mental asylums and treated as psychologically disordered.

Why are they detained?

The Act allows people considered to be mentally ill to be detained in hospital and given treatment against their will.

They do not have to commit a crime or have harmed anyone.

They are usually detained because it is considered in their interests and for their own safety, but they may be held because they are deemed a risk to others.

Medication for mental disorder can be prescribed and administered to some categories of patients detained under the Mental Health Act without their consent for a period of three months.

After that, medication can be administered only in certain circumstances.

Community care patient Christopher Clunis killed a man after stopping taking his medicine

The Act covers allows for detention for several different periods.

People can be detained against their will for 28 days if two doctors agree to their committal.

This part of the Act is usually used for patients being detained for the first time for assessment.

Patients may also be detained for up to six months, but this requires the consent of the person's nearest relative. This order can be renewed after six months and then annually.

Patients can also be admitted under an emergency order on the recommendation of a doctor.

And voluntary patients can be prevented from leaving if they are still deemed a risk to themselves and the public.

The Act covers other orders, including guardianship and people detained as a result of a criminal trial.

Appeals against detention

The Act is not very specific about appeals and mental health charities say patients need more rights to contest a detention order.

Patients or their relatives can apply for a hearing before the Mental Health Review Tribunal if they want to be released.

However, it can often take some time before a case is heard.

Mental health charity Mind wants legislation to give patients the right to independent representation and advocacy for appeals.

Many health trusts bypass the Act and commit people informally, which means they have no right of appeal.

A recent court case concerning an autistic man who was held informally for years, despite his guardians' protests, was overturned by the House of Lords.

It could have meant a huge increase in committals under the Mental Health Act.

What is the government's position?

The government has said it wants to introduce new legislation to force people released from hospital to take their medicine.

Mental health charity the Zito Trust says many of the murders by community care patients have been the result of patients failing to take their medicine on release from hospital.

The government is thought to be planning to introduce a new order which would allow a person who refuses to take their medication to be detained.

Mental health organisations are worried about the civil liberty implications of such orders.

SANE says they should only be used in extreme cases and that the first priority should be more resources to support people living in the community.